The present invention relates generally to devices and techniques for remodeling the atrial appendage of a mammal. The process takes place through the pericardial space from an access point outside the pericardium or pericardial space.
The atrial appendage is an anatomic feature of the left atrium of the human heart. It is widely believed that atrial fibrillation results in a pooling of blood in the atrial appendage which results in clots.
The surgical removal of the atrial appendage through a limited thoracotomy has been proposed by Johnson in U.S. Pat. No. 5,306,234. However, the surgical removal of the appendage remains problematic since the surgical intervention occurs under general anesthesia and is considered major surgery. It should also be realized that even a transluminal minimally invasive approach from inside the heart is problematic since such an approach requires an implantable closure device and has the risk of acute stroke. Typically any closure device left in contact with the interior of the heart is potentially a thromobogenic surface.
For these reasons among others there is a continuing need to improve techniques for occluding or removing the left atrial appendage.
In contrast to the prior art, the present invention teaches devices and methods of using the devices to remodel the atrial appendage from locations outside the heart but within the pericardial space. In use, the pericardial space is accessed via the chest wall below the rib cage and an endoscope is inserted. It is preferred to perform the process steps under visual guidance although robotic and other location technologies may be used in the alternative. The preferred treatment for the appendage is xe2x80x9cwet cauteryxe2x80x9d where the size and therefore the volume of the appendage is reduced. An alternate preferred device cuts and cauterizes while removing the appendage. Other surgical techniques are useful as well including conventional electrosurgery and cautery and conventional suture and staple techniques. In all instances the volume of the appendage is reduced and in some approaches tissue is removed as well.